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Introduction: Surgical education is of paramount importance in an environment of reduced resident work hours and rising medical costs.  The cadaver-based surgical simulation provides an adjunct towards training safe, efficient and competent surgeons.  A recent analysis of resident education under the Accreditation Council Graduate Medical Education (ACGME) duty hours limitations demonstrated no negative impact on operative experience.  However, programs are seeking alternatives to traditional surgical education.  We implemented a curriculum for learning and executing carpal tunnel release based on three proven methods of adult learning.  Our objective was to determine whether participants who used multiple means of learning benefited more than those who prepared with surgical a textbook alone.

Methods: Participants from various levels of training were randomly assigned to one of three groups (A-C) such that each group consisted of a medical student, a plastic surgery PGY2, and a PGY5 resident.   Groups received up to three progressive levels of instruction, with group A reading from Green’s chapter, “Median nerve compression at the wrist”, while group B additionally viewed a narrated video of the surgery, and group C additionally observed an attending surgeon perform the cadaver surgery.  All participants were then videotaped performing decompression of the median nerve at the carpal tunnel on a fresh, frozen cadaver.  Three blinded CAQ surgeons subsequently scored each participant’s video using the Global rating scale of operative performance (GAS).  Participants were also subjected to a pre- and post-surgery survey detailing their confidence level for performing various aspects of the operation.

Results: A comparison of pre- and post-surgery confidence tests revealed a median gain score of 1 (on a scale of 1-5) for each question, which was unrelated to training level or level of instruction.  GAS scores had acceptable inter-rater reliability, and were positively correlated with training level, but not instruction level.

Conclusions: Regardless of training level, surgical trainees can benefit from a cadaver-based surgical skills curriculum.  While additional multimedia and attending instruction may reinforce surgical concepts, much benefit can be derived from pre-reading alone, raising the prospect of a resident-initiated and administered cadaver-based curriculum.